Mr. Diaz was admitted for work-up of two months of episodic severe headaches, palpitations, and drenching sweats. Imaging identified an adrenal mass. During the admission physical exam, as the nurse begins to palpate his abdomen, he suddenly grips the bedrail and reports a pounding headache.
Before you move on, notice:
What is the priority nursing action?
Continuing to manipulate a catecholamine-secreting tumor is what's driving this surge. Finishing the exam right now makes the crisis worse, not better.
Manual pressure on a pheochromocytoma can trigger a massive catecholamine release, which is exactly what this sudden spike in blood pressure and heart rate looks like. Removing the stimulus and getting the provider involved immediately is what stops the surge from escalating further.
A loop diuretic doesn't touch the catecholamine surge driving this crisis, and it isn't the ordered or appropriate response to a hypertensive emergency like this one.
Valsalva is a vagal maneuver used to slow a tachyarrhythmia like SVT. It does nothing for a catecholamine-driven hypertensive crisis and isn't indicated here.